随着光学一致性断层相对血管内超声波引导皮肤冠状动脉干预的临床结果:随机对照试验的元分析
Sheriff N Dodoo1, Sammudeen Ibrahim2, Abdul-Fatawu Osman3
1Northeast Georgia Medical Center, Georgia Heart Institute, Gainesville, Georgia, USA.
概括
光学连贯断层扫描 (OCT) 引导的穿皮冠状动脉干预 (PCI) 与导向的静脉内超声波 (IVUS) 引导的PCI相比,减少了外周手术并发症. 然而,在两种成像方法之间,长期的结果,如主要的不良心脏事件,是相似的.
科学领域:
- 心脏病学 心脏病学
- 医疗成像医学成像
- 干预心脏病学 干预心脏病学
背景情况:
- 光学连贯断层扫描 (OCT) 和血管内超声波 (IVUS) 是用于增强冠状动脉支架植入的冠状动脉内成像工具.
- 对OCT与IVUS对临床结果和周围手术并发症的比较影响尚不清楚.
研究的目的:
- 进行随机对照试验的元分析,比较OCT指导与IVUS指导的皮肤冠状动脉干预 (PCI).
主要方法:
- 在MEDLINE,Cochrane图书馆,Scopus和clinicalTrials.gov数据库中进行了系统的搜索,截至2024年2月.
- 包括7项随机对照试验,涉及4446名患者.
- 主要终点是30天的主要不良周围过程事件 (MAPE);次要终点包括各种心脏事件和1年死亡率. 分析使用了一个随机效应模型.
主要成果:
- 与30天后IVUS引导的PCI相比,OCT引导的PCI与显著较低的MAPE (OR:0.65,CI:0.47-0.91,p=0.01) 相关.
- 在OCT和IVUS之间30天后,在支架血栓形成,远端栓塞或远端边缘剖析方面没有发现显著差异.
- 一年后,主要心脏不良事件 (MACE),全因死亡率,心脏死亡,目标血管心肌梗塞 (TVMI),目标血管再血管化 (TVR) 或非致命性中风没有显著差异.
结论:
- 与IVUS指导的PCI相比,OCT指导的PCI在30天内显著减少了外围手术并发症.
- 尽管有短期益处,但OCT和IVUS指南在1年后产生类似的长期临床结果.
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